Symphysis sits in the pelvis

The symphysis is 1 of the 3 joints that hold the bony pelvis together. The symphysis is located in the middle of the front of the pelvis, just below your pubic hair. At the back of the pelvis, above your buttocks, are the two sacroiliac joint also called the SI joints.

The symphysis is the joint where the pelvic bones - the pubic bone - meet on your front.

The symphysis and sacroiliac joints are all made of cartilage. During pregnancy, they are affected by the hormone relaxin. A brilliant hormone that softens these joints so that the bony pelvis can give a little and thus create space for the baby to penetrate down through the pelvis during birth.

Impact on the symphysis

The symphysis plays an important role in absorbing shocks, for example when walking. During pregnancy, there is also an increase in weight on the symphysis as the belly grows. In the latter part of pregnancy, some babies lie for a shorter or longer period of time in such a way that their head “rides on the symphysis”, which feels completely uncomfortable and is completely harmless. In addition, increased fluid in the body can also affect the cartilage tissue of the symphysis and the changed posture during pregnancy can put increased strain on the symphysis.

Furthermore, a large number of muscles, fascia and ligaments attach to the area around the symphysis. All of them are put to extra work during pregnancy, which also puts extra strain on the symphysis.

The symphysis is exposed to a little bit of everything throughout pregnancy, which can cause pain.

Many pregnant women experience tenderness at the pubic symphysis, for example when it is pressed during a midwife visit, when the abdomen is symphysis fundus measurement (the measurement from the top of the pubic symphysis to the top of the uterus) should be measured. This is completely normal.

How do you take care of your pubic symphysis?

When pregnant, it's a good rule of thumb to imagine that you're wearing a semi-tight skirt that keeps your legs hip-width apart at all times. That means not crossing your legs (yes, I know, it's a really hard habit to change, but sitting without your legs crossed is a total pain in the ass) and not sitting in extreme positions, such as the tailor's position with your legs. And yes, I know that some people enjoy this position - even during pregnancy, but for the vast majority, the tailor's position will cause pain in the ass over time.

Mobility is also good. When we sit or stand still for a long time, for example at work, our joints become stiff. If you have a sedentary job, I would therefore highly recommend that you sit on a Pilates ball that is the right size for you. You can google a size guide. Make sure the ball is well inflated. When you sit on a Pilates ball, you automatically have a straight back and flat feet on the floor at hip width. And without thinking about it, you move a little from side to side or jump a little. It is simply almost impossible not to 😉 Regardless of whether you sit on a ball or not, it is good to get up and walk every hour. It can be back and forth to the toilet, out to make a cup of tea or the like. In addition, it is always good and important to listen to your body. Is a walk in the evening too much for your symphysis? Then take a bike instead. If breaststroke causes pain in the symphysis, swim crawl (legs) instead. Because movement is good as long as you listen to your body. Maybe you need to modify, scale down or change your forms of movement?

And dear, you should also remember to rest. Lie down a few times during the day. Preferably with a good pillow between your thighs/knees. That's pure synphysial care!

What does symphysis pain feel like?

Symphyseal pain is often experienced as pain directly in the symphysis area. It can feel like aching, stabbing, throbbing, burning, warmth, and swelling.

The pain can occur suddenly in connection with a movement, for example crossing your legs, or it can occur later, for example after a long walk. I can't count how many beautiful women have come staggering to my clinic with pubic symphysis pain after yesterday's slightly (much) too long shopping trip 🙂

In addition, there may be more or less constant pain in the symphysis, which feels more like a murmur or tender swelling.

Symphysis release

With the word symphysis release, refers to symphysis pain. Previously, they were called dislocation. However, this gives completely wrong associations, since nothing in the symphysis is loose and nothing can fall apart. Many people also confuse symphysis dislocation and pelvic dislocation. Pelvic dislocation must be diagnosed by a doctor and involves all 3 joints in the bony pelvis, both the symphysis AND the 2 sacroiliac joints at the back.

Symphyseal release is symphysis pain. In some pregnant women, the pain can affect both sleep and quality of life to such an extent that it also affects both work and leisure.

What can you do about symphysis pain?

In addition to the above advice on how to care for your pubic symphysis, there are a number of things you can do to relieve your pubic symphysis pain.

• There is a special acupuncture technique called periosteal acupuncture. It takes a few minutes, hurts during the time and for many pregnant women provides relief for hours to days afterwards. The treatment should be repeated 3-4 times over a few weeks and can be combined with more general relaxing and calming acupuncture, which can be a relief if you are tense due to symphysis pain.
• Rebozo can relieve symphysis pain for some. Book an appointment with a private midwife who will guide you and your partner in rebozo exercises that suit your exact symptom picture. One of the magic things about rebozo is that as a pregnant woman you have nothing to do but receive. And you as a partner have the opportunity to melt and relieve pain in your pregnant woman's body.
• Place a piece of smooth fabric under your sheet at hip height. This makes it significantly easier for you to turn over at night. The same applies if you sit on a smooth scarf, a smooth bag or similar in the car, it is easier to get in and out - preferably with your legs as close together as possible to take care of your pubic symphysis.
• Some pregnant women experience significant pain relief by walking with a pelvic belt . Try it out to see if it helps you and remember that it doesn't mean you should just go about your daily life without any pain. Just remember to take good care of your symphysis and listen to your body's limits and messages.
• Strengthen your pelvic floor. And relax your pelvic floor. It may sound contradictory. But it actually goes hand in hand. Because it's good to have strong muscles. And it's also important to be able to relax your muscles so they're not constantly tense.

The muscles in the pelvic floor help to hold the pelvis and thus have an impact on the symphysis.

• Seek help. There are more and more physiotherapists with passion and vast knowledge about the pregnant pelvis. Seek them out for a treatment and/or for guidance on exercises you can do at home.
• Put on some music and swing your hips. I know it's not a complete pain-relieving method. But movement increases blood flow and can, for example, help your baby settle into the pelvis, so there's less pressure on the symphysis. And then dancing brings smiles and joy and boosts your oxytocin which is the love and well-being hormone. There is also ample opportunity to invite your partner to the living room or kitchen dance floor. So pure win win 🙂

Most affectionately

Siff Stephenson, HeartMidwife